Total Expenditure Research Articles

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States.

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States. To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016. The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending. Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure. Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Measuring energy expenditure in narcolepsy using doubly-labelled water and respiration chamber calorimetry.

Hypocretin deficiency causes type 1 narcolepsy, a condition characterised by excessive daytime sleepiness, cataplexy, and fragmented nocturnal sleep. Two-thirds of people with narcolepsy are also overweight, of which half are obese. The pathophysiology behind weight gain in people with narcolepsy remains unknown. We assessed a possible decrease in energy expenditure as a cause for overweight in narcolepsy using respiration chamber calorimetry and doubly labelled water. Ten males with type I narcolepsy and nine matched (for age, sex, and BMI) healthy controls were enrolled. Subjects stayed in a respiration chamber for 24 hours. They subsequently received doubly labelled water and wore an accelerometer for two weeks to assess energy expenditure and physical activity under daily living conditions. Total daily energy expenditure, resting energy expenditure, overnight metabolic rate, physical activity level and activity-induced energy expenditure were measured. No significant differences were found in resting energy expenditure, mean 24-hour respiration chamber energy expenditure, overnight metabolic rate and activity-induced energy expenditure when comparing people with narcolepsy type 1 to controls. Physical activity was also comparable between groups. Energy expenditure in narcolepsy type 1 is similar to matched controls, suggesting comparable metabolism and physical activity rates. It remains possible that metabolic changes are most pronounced around disease onset. In addition, patients had to discontinue their medication which may have influenced the results. Still, our findings suggest that other factors may also play a role in weight gain in narcolepsy, such as differences in dietary behaviour.

Post-Exercise Hypotension after Exercising in Hypoxia with and Without Tart Cherry Supplementation.

Horiuchi Masahiro and Samuel J. Oliver. Post-exercise hypotension after exercising in hypoxia with and without tart cherry supplementation. High Alt Med Biol. 00:00-00, 2024. Background: This study investigated the effects of hypoxic exercise with and without tart cherry (TC) supplementation on post-exercise hypotension (PEH). Method: In a randomized order, 12 healthy young adults (9 men and 3 women) completed cycle exercise to exhaustion (1) in normoxia without any supplementation (Norm), (2) in hypoxia (13% O2) with placebo (Hypo), and (3) in hypoxia with TC supplementation (Hypo + TC). Supplements were supplied for 5 days pre-trial (TC was 200 mg anthocyanin per day for 4 days and 100 mg on day 5). Results: Cycle exercise total energy expenditure was greater in Norm than Hypo and Hypo + TC (p < 0.001) with no difference between Hypo and Hypo + TC (p = 0.41). Mean arterial pressure (MAP) decreased during recovery in all trials (main effect of time, p < 0.001), with no difference in PEH between the trials (p > 0.05, change [Δ] in MAP from pre-exercise at 60 minutes recovery, mean difference, Norm Δ-4.4 mmHg, Hypo Δ-6.1 mmHg, and Hypo + TC Δ-5.2 mmHg). Cardiac baroreflex sensitivity decreased during recovery in all trials (p < 0.001) and was lower in Hypo than Norm and Hypo + TC (main effect of trial, p = 0.02). Conclusion: PEH was not increased after exercise in hypoxia, with or without TC supplementation, compared with exercise in normoxia.

Corrigendum: Analysis of the structure and trend prediction of China's total health expenditure

Corrigendum: Analysis of the structure and trend prediction of China's total health expenditure

Abstract 4145880: Incidence and Outcomes of Acute Myocardial Infarction (AMI) in Hematological Malignancy Patients: Systematic review and Meta-analysis

Background: Patients with hematological malignancies may face increased cardiovascular risks, including acute myocardial infarction (AMI). This systematic review and meta-analysis aims to evaluate the incidence and outcomes of AMI in patients with hematological malignancies compared with the general population. Methods: A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Random effect models were utilized to calculate Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs). The inverse variance method with DerSimonian–Laird (DL) of Tau2 was used to calculate standardized mean differences (SMDs) with CIs. Statistical significance was set at p &lt; 0.05. The primary endpoint was the incidence of AMI, while secondary outcomes included in-hospital mortality, length of hospital stay, likelihood of undergoing invasive procedures, total hospital costs, bleeding events, and stroke outcomes. Results: Twenty-six articles, including approximately 6.33 million patients with hematological malignancies, were included in the meta-analysis. Hematological malignancies were not associated with an increased incidence of AMI compared with the general population (OR = 0.91; 95% CI 0.80 to 1.03; p&lt;0.001). AMI in hematological malignancies was associated with an increased risk of in-hospital mortality (OR = 1.71; 95% CI 1.57 to 1.86; p&lt;0.001), bleeding event (OR = 1.30; 95% CI 1.12 to 1.60; p&lt;0.001), and stroke (OR = 1.24; 95% CI 1.09 to 1.42) compared with AMI in the general population. Patients admitted due to AMI in hematologic malignancies also experienced an increased length of stay (SMD = 0.25; 95% CI 0.20 to 0.28; p&lt;0.001) compared with AMI in the general population. There was no significant difference between the two groups in terms of the likelihood of undergoing invasive procedures (OR = 0.62; 95% CI 0.56 to 0.69) or total hospital expenditure (SMD = 0.09; 95% CI -0.01 to 0.19). Conclusion: While hematological malignancies do not appear to increase the incidence of acute myocardial infarction (AMI), patients who experience AMI episodes are at higher odds of in-hospital complications.

Excess costs of depression among a population-based older adults with chronic diseases in Singapore.

There is limited evidence on the economic burden of depression among the older population in Singapore. We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore. Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution). For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490-14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7-475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163-1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418-12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346-1010; p < 0.001). This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore's primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias. Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

Nutrition among nursing home residents: results from the NutriCare study

BackgroundOlder adults living in nursing homes (NHs) are considered a vulnerable population in terms of nutrition. The aim of the present study was to explore the usual intake of energy, macronutrients, and specific food groups, along with offers in the NH menus on a nationally representative sample of Slovenian NH residents and compare dietary patterns with the established recommendations.MethodsThe study was conducted as part of a cross-sectional NutriCare study on 317 residents (65–101 years) from 20 Slovenian NHs in 9 health regions. Relatively independent residents were selected using quota sampling by sex and age. Data collection involved interviews and anthropometric measurements. Usual dietary intake was assessed by a multiple-source method from two 24-h dietary recalls and food frequency questionnaires. Adherence of dietary intake to the recommendations and dietary composition of NH menus were assessed. The Mini Nutritional Assessment (MNA) was used to explore nutritional status.ResultsNotable variability in energy and macronutrient intakes was observed with some participants showing intakes below and others above the recommended values. A high prevalence of BMI &amp;gt; 30 kg/m2 was observed in 39% of participants, indicating potential discrepancies between total energy intake and expenditure. The usual intake of fat was 36% of total energy intake (TEI). The intake of foods of animal origin exceeded dietary guidelines. Intake of carbohydrates (46% TEI in men and 47% TEI in women) as well as dietary fibre (20 g/day for both sexes) was below recommendations. A scarce intake of fruits, vegetables, and cereals was observed. In total, 40% of men and 35% of women had usual daily protein intakes lower than 1 g/kg of body weight. The protein content of breakfast and dinner could be improved. NH residents consumed little food from outside NH. The usual nutrient and food group intakes of residents reflected the NH menu offers.ConclusionThe study results on the usual intake of energy, macronutrients, specific food groups, and offers in the NH menus indicate the potential for optimisation. According to the World Health Organisation, the prevalence of BMI &amp;gt; 30 kg/m2 is notable and warrants attention. Careful meal planning and regular monitoring of the nutritional status of NH residents should be considered.

State and Local Government Expenditures and Infant Mortality.

A previous study reported that increased state and local government expenditures were associated with decreased infant mortality rates (IMRs). However, reported estimates of the association between expenditures and IMR represented the degree to which the association changed each year, not the main effect. We reproduced the original results, reporting this main effect and replicated the analysis using improved methodology and updated data. For the reproduction analysis, we used methods and data identical to the original study: A publicly-posted, state-level data set of expenditures from 2000 to 2014 US Census Bureau survey data linked to 2-year lagged IMR data with a random intercept model including an interaction between time and expenditures. For the replication analysis, we added 5 years of data and adjusted for fixed state differences and inflation. In the reproduction, the main effects of total, environmental, and educational expenditures on IMR were much larger than the interaction effects previously reported as the main effects. For example, a 1-SD increase in per-capita total expenditures was associated with a reduction of 0.35 infant deaths per 1000 live births instead of 0.02 deaths per 1000 live births originally reported. In the updated replication, the main effects were generally even larger (eg, -0.51 deaths per 1000 per SD increase in total expenditures). Increased total expenditures were associated with absolute but not relative reductions in Black-white IMR gaps. State and local government expenditures are associated with greater reductions in IMR than previously reported, underscoring the importance of continued public investment.

Forecasting Financial Expenditures for Long Term Care Insurance Evidence from the Typical Pilot Cities in C

Purpose: This study aims to provide decision-makers with a reference by predicting the financial expenditures and trends of long-term care insurance in China over the next thirty years. Approach/Methodology/Design: This study employs Markov chains and overall simulation model to forecast the extent of financial expenditures on long-term care for employees and residents. It examines the financial outlay levels under various entitlement payment scenarios and estimates the discrepancies in financial expenditures between employees and residents from 2021 to 2050. Findings: The results show that (1) The number of disabled elderly employees aged 60 and above will be about 14,288 thousand, and the number of disabled elderly residents will be about 68,176 thousand in 2050. (2) Under the low scenario, the financial expenditures of elderly employees and residents in 2050 will reach 29,636.87 million yuan and 17,597.92 million yuan respectively, which are 2.86 and 10.24 times as much as those in 2021. The total financial expenditures under the medium and high scenarios will be 2.38 and 5.51 times as much as those under the low scenario respectively. (3) The scale of financial expenditure on long-term care insurance for residents far exceeds that of employees, and the trend is expanding. Practical Implications: This study may provide theoretical support for the full implementation of long-term care insurance policies. Originality/value: This study uses Markov models and overall simulation models, along with typical representative plans from pilot areas in China, to differentiate the insurance identity of elderly employees and residents and to estimate the scale and trend of financial expenditures for long-term care insurance in China from 2021 to 2050.

The role of Pharmaceutical Marketing in Prescribing Decisions in a Developing Country: A Comprehensive Study Exploiting Theory of Planned Behaviour

Background: Prescription medicines have become a major component of health systems in both developed and developing countries contributing to, may be, more than half of the total health care expenditure in the developing countries. Although literature directly attributing rise in medicines expenditure to prescribers’ decision, but still only a few researches had employed studies with sound theoretical foundations to comprehensively examine prescribing decision behaviours. Our objective was to investigate potentially modifiable factors, which may influence prescribing decisions of physicians employing theory of planned behaviour. Method: A quantitative survey approach was used to investigate the proposed hypotheses. Population was physicians in outpatient clinics in both private and governmental hospitals in Sana’a, capital city of Yemen. A structured questionnaire was designed to measure the influence of drug-promoting marketing techniques on physicians’ prescribing decisions. Data was collected through an anonymous survey questionnaire. The hypotheses were tested by multiple regressions analysis. Ethical approval was obtained from the Ethical Committee of the Ministry of Public Health and Population (MoPHP), and participants provided written consent before enrolling in the study. Result: Physicians admitted the presence of promotional influence on their prescribing decision. The study revealed that receiving low-value promotional items, belief of physicians that it is appropriate to accept both low- and high-value promotional items, physicians’ exposure to company-direct sources of information, and drug promotion-related factor all are positively and significantly related to physicians’ prescribing decisions (? = 0.438, p &lt;0.001; ? = 0.089, p =0.027; ? = 0.157, p &lt;0.001; ? = 0.093, p =0.032; and ?= 0.118, p = 0.007 respectively). Conclusion: This research clarified the role played by pharmaceutical companies to influence prescribing decisions of physicians. Therefore, could provide theoretical framework for policymakers in Yemen, and other countries with similar conditions, to develop a suitable policy and strategy in terms of drug promotion.

Kinerja Pendapatan dan Belanja Kota Malang Tahun 2018–2023

Evaluation of Regional Government financial performance is important and needs to be carried out. The aim of this research is to check the financial performance of the Malang City Government by analyzing financial reports from 2018 to 2023. This research is descriptive qualitative with secondary data obtained from the Malang City Central Statistics Agency. The results show that the degree of decentralization ratio has an average of Fair Performance, the financial independence ratio has an average of Low Performance, the efficiency ratio has an average of Inefficient Performance, the ratio of operational expenditure to total expenditure has an average of Good Performance, the ratio of capital expenditure to total expenditure with average Good Performance, and ratio of expenditure growth with average Good Performance.

Anthropometric profile and dietary intake of amateurs and professional mixed martial arts athletes

Nutritional habits and anthropometric profiles are directly linked to competitive performance; however, there is a great lack of information on amateur or professional mixed martial arts (MMA) athletes outside the competitive period. The aim of this study was to compare food consumption and anthropometric profile of amateur and professional MMA fighters. The sample was composed of 24 male MMA athletes, middleweight category (age: 27.5 ± 5.0 years; body mass: 79.0 ± 12.1 kg; height: 173.5 ± 0.1 cm; %BF: 19.5 ± 4.0 %, BMI: 26.0 ± 2.8 kg/m2). Food consumption was evaluated based on three 24-hour food diaries using the Multi-Step method in a non-competitive period and analyzed using the Dietbox v2.92 software. The professional group was younger (p = 0.001) than the amateur group. Total energy expenditure was similar between amateur (4364 ± 469 kcal) and professional (4312 ± 381 kcal). Amateur and professional reported an energy deficit between the estimated energy requirement and energy intake. Carbohydrate consumption was below the suggested minimum limits (amateur: 3.3 ± 1.6g/kg/day and professional: 3.3 ± 1.4g/kg/day). Protein intake was within the suggested limits (amateur: 1.4 ± 0.9g/kg/day and professional: 1.8 ± 0.8g/kg/day) and lipids presented borderline values about to with concerning the recommendations in the literature (amateur: 0.9 ± 0.6 / g/kg/day and professional: 1.8 ± 0.9 g/kg/day). Amateur and professional athletes did not differ in terms of food consumption and anthropometric profile. Both groups, amateur and professional, demonstrated negative energy balance and inability to reach the suggested levels of macronutrient intake according to the classification. Thus, it is recommended that both MMA groups receive attention regarding nutritional strategies.

Performance evaluation of child welfare departments using Data Envelopment Analysis: A comparative study across US states

Public child welfare agencies play a pivotal role in safeguarding the well-being of children and thus, the future of our society. While the performance of child welfare agencies is of critical importance, limited previous research relying on operations research and advanced analytics appears to exist in the analysis of their performance. We conduct a multi-criteria analysis for benchmarking the performance of the United States child welfare system, using Data Envelopment Analysis (DEA) to evaluate the performance of public child welfare agencies across different US states. We select as outputs various statewide data indicators from the Child and Family Services Review (CFSR), while our inputs include the total annual expenditure by each state on the child welfare system. We use clustering to differentiate agencies based on the presence of the “Alternative Response” policy, which provides for preventive and support options for families, and apply DEA to each homogenous cluster. We identify best-practice agencies and provide benchmarks for the remaining agencies to enhance their performance. Our study offers data-driven directions for child welfare agencies to improve safety and permanency outcomes for children.

Towards Environmental Sustainability: The Impact of External Debt and Government Expenditure on Carbon Emissions in Somalia

This study aims to assess the effect of external debt and government expenditure on carbon emissions in Somalia. To do so, the study employed a rigorous econometric approaches such as autoregressive distributed lag model (ARDL), Fully modified least square (FMOLS), and Dynamic least square (DOLS). Findings demonstrated that external debt (LNED) positively and significantly affects carbon emissions. Results revealed that a 1%, or a point increase of external debt, rises 0.29% into the emitted emissions. Moreover, the study found that the long-run coefficient of government expenditure (LNGE) positively correlates with emissions. However, a 1% increase in total government expenditure significantly increases CO2 emissions by 0.05% in the long run. So, regarding the positive correlation between external debt, government expenditure, and carbon emissions, the study suggests that the government should strategically use its expenditures and external debt to fund environmentally sustainable projects. This approach aims to reduce carbon emissions while promoting sustainable development and balancing economic growth with ecological conservation.

Nutritional Risk, Nutritional Status and Some Biochemical Parameters In Adult Burn Patients in Burn Intensive Care Unit: A Prospective Study

Nutritional therapy is very important in burn patients and plays a role in the prevention and treatment of malnutrition. Therefore, it is necessary to assess nutritional status, prevent or minimize nutritional problems, and monitor nutritional therapy. This study was conducted to determine the nutritional risk, nutritional status and biochemical parameters of adult burn patients in the burn intensive care unit. The 59 patients (women: 16, men: 43) between the ages of 19-64 were included in the study. Parameters such as NRS-2002 (admission and discharge), dietary intake, nutritional support status, serum albumin, and total protein (admission and discharge) were evaluated to determine the nutritional risk and nutritional status of the patients. In addition, body weight, mid-upper arm circumference, and triceps skinfold thickness were measured and body mass index was calculated (admission and discharge). The duration of hospitalization and burn percentage of men patients were higher than women (P &lt; 0.05). A significant decreases were determined in the mean body weight, body mass index, and triceps skinfold thickness of men patients at discharge compared to admission (P &lt; 0.05). In men patients, a statistically significant difference was found in serum albumin, hemoglobin, and hematocrit values between admission and discharge (P &lt; 0.05). A statistically significant difference was found in NRS-2002 scores at admission and discharge in both genders, and the scores increased (P &lt; 0.05). While a significant relationship was found between immunonutrition support and gender (P &lt; 0.05), no relationship was found between genders in terms of the diet given and the consumption status of the diet intake (P &gt; 0.05). No statistically significant difference was found between genders in terms of feeding duration with nutritional support products, energy intake with nutritional support products and diet, macronutrients, and total energy expenditure values (P &gt; 0.05). Since burn injuries can cause serious metabolic disorders, impaired nutritional status was encountered during hospitalization. While the treatment process was positively affected by the increase in the NRS-2002 score during hospitalization, a decrease in parameters such as albumin, total protein, and anthropometric measurement values brought about by the catabolic process was encountered. Therefore, to prevent or treat malnutrition, the nutritional status of patients should be evaluated at the time of hospitalization and they should be able to receive the necessary nutritional support.

Energy expenditure, metabolic adaptation, physical activity and energy intake following weight loss: comparison between bariatric surgery and low-calorie diet.

Bariatric surgery remains the most effective treatment to achieve substantial weight loss; however, total daily energy expenditure and physical activity changes in response to such interventions have been seldom explored. In this prospective observational study, total daily energy expenditure (TDEE) using doubly labeled water and physical activity (SenseWear armband) was assessed in 17 females (mean ± SD: 48.6 ± 9.7 kg/m2, 43 ± 12 years) at baseline and 8 and 52 weeks following either bariatric surgery (BSG, N = 9) or a low-calorie diet (LCD, N = 8). Energy intake was assessed using the intake-balance method. After 8 weeks, weight loss was 16.0 ± 3.5 kg and TDEE decreased by 552 ± 319 kcal/d in BSG (P < 0.001) compared to 8.8 ± 3.4 kg and 256 ± 239 kcal/d in LCD (P < 0.05). After 52 weeks, weight loss was 44.3 ± 16.4 kg and TDEE decreased by 583 ± 418 kcal/d (P < 0.001), compared to 4.3 ± 6.7 kg and 84 ± 285 kcal/d in LCD (P > 0.05). TDEE was lower than predicted in BSG at 8 (P = 0.03) but not 52 weeks (P = 0.77). There was no evidence of metabolic adaptation in LCD. Average daily energy intake in BSG was 1403 ± 245 kcal/d compared to 2545 ± 398 kcal/d in LCD (P < 0.001). In BSG, step count and physical activity minutes were increased at 52 weeks compared to baseline (P = 0.03), whereas no significant changes were observed in LCD. Bariatric surgery-induced weight loss decreased TDEE at 8 weeks and 1 year, resulting in metabolic adaptation after 8 weeks that was reversed at 1 year. These changes were accompanied by an increase in physical activity.

Poverty and resilience impacts of conservation agriculture adoption against climatic-shocks in Eastern Ethiopia

The aims of this study are to analysis adoption and impacts of conservation agriculture on poverty and resilience to drought in Eastern Ethiopia. Multi-stage sampling method was employed and four districts were randomly selected from Eastern Hararghe Zone. Using cross-sectional survey data collected in 2023 from 430 households, multinomial endogenous switching regression was applied in impact evaluation. The result shows farm experience, education, climatic-shocks experience, access to climate information, access to extension, number of oxen, farm size, labor force, livestock and distance to market are determinants of conservation agriculture (CA) adoption in terms of inter-cropping, crop rotation and crop residue retention or mulch practices in its single and combination of practices. Poverty was evaluated based on cost-of-basic-need and resilience to drought is in its index. Accordingly, the food poverty line and total consumption expenditure or total poverty line was found to be 6582.7ETB and 8620.70ETB per Adult/Equivalent per year in the study area. Results of average treatment effect on treated shows adoption is significantly reduced poverty and increased resilience to drought condition in the area. The study also shows importance role of extension service in adoption of CA practices. There is a need to encourage extension facilities and awareness to promote better adoption of CA particularly, in its combination. The combination of practices increased consumption expenditure of adopters by 73.3 percent compared to non-adopters, given its significant impact on households’ poverty and resilience to drought in moisture stress area of eastern Ethiopia. So, it is crucial to more advances farmers and experts’ information on climate shocks and conservation agricultural practices adoption. The policymakers ought to develop and encourage farmers’ asset building plan including livestock, adult education, market linkage facilities, extension and weather related information delivery service to enhance adoption of conservation agricultural practices to combat the current and future drought.

Solutions for reducing the severe economic burden of musculoskeletal diseases

Abstract Issue In Slovenia the big group of over 150 musculoskeletal and connective tissue diseases (MSCTD) constitute a serious public health problem, a major burden on health systems and society as a whole. Patients with these diseases have a poorer quality of life and often retire early. Any early retirement that could have been prevented represents a loss of human capital, which is a major social and economic cost to society. The aim of this study was to analyze the economic burden of the six most common MSCTD in Slovenia for the period from 2020 to 2022, to contribute to a better understanding of this problem and suggest solutions. Methods At the Slovenian National Institute of Public Health, in collaboration with the Faculty of Economics at the University of Ljubljana, we calculated the burden of six most common MSCTD for the period 2020-2022. We used the National Transfer Accounts (NTA) methodology to calculate the indirect costs; direct costs were calculated based on the national routine health data. Results The calculated economic burden of the six most common diagnoses of MSCTD represents 5% of total health expenditure or 0.4% of Slovenian gross domestic product on average. Direct costs amounted to 2% of total health expenditure (hospitalizations 22.5%, costs for medicines 9.3%, first curative visits at the primary level and visits to the outpatient clinic at the secondary level 2.7%). Indirect costs amounted to 3% of total health expenditure. Conclusions Despite the reduced access to the health system due to COVID-19 the economic burden of MSCTD is high in Slovenia and would be significantly higher considering all diagnoses from this group of diseases. The research requires interdisciplinary cooperation between medicine and economics regarding demanding NTA methodology which is innovative in our country. Key messages • One of the main public health priorities in Slovenia should be to raise awareness of MSCTD. • In the light of the aging population prevention activities with focus on MSCTD should be intensified as soon as possible.

Are post-communist countries paying increased healthcare costs because of risky behaviour?

Abstract Background Based on the annual Country Health Profiles, we can see the difference in population behaviour across EU countries and the associated health risks. At first glance, the so-called post-communist countries are characterised by above-average per-capita harmful consumption of sin goods, alcohol and tobacco. Is this harmful consumption associated with increased healthcare costs? Methods The idea of the study is based on balanced panel-data published in Country Health Profiles. The member countries were divided into groups based on their health risk scores - high risk (above average), and low risk (below average). The group of countries with high risk is mostly composed of post-communist countries. The detailed per-capita annual data for the period 2013-2021 was collected, such as GDP, consumption of sin goods, alcohol, and tobacco. The analysis is based on fixed-effects linear regression models, following recent recommendations on suppressing the excessive role of statistical-inference tools. Results We built various models for different groups of countries, and in this abstract, we present results for the group of post-communist countries - a simple model of harmful consumption (sin goods, GDP) and a more complex model (alcohol, tobacco, GDP). The results show that in the case of the post-communist countries group, for a fixed level of GDP per capita, higher consumption of sin goods by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 0.244 per capita. For a fixed level of GDP per capita and tobacco consumption per capita, higher consumption of alcohol by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 1.367 per capita. Conclusions Harmful consumption has a multiplier effect in the health sector; besides direct impact, it influences an increase in healthcare expenditures. More emphasis should be placed on prevention and awareness of consumers to reduce harmful consumption. Key messages • For fixed GDP per capita, higher harmful consumption corresponds with higher healthcare costs in post-communist countries. • For fixed GDP per capita and tobacco consumption per capita, a €1 higher alcohol consumption corresponds with more than €1 higher healthcare expenditure in the post-communist countries.

Development of health care expenditures in Finland up to 2040

Abstract Background Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments. Methods We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures. Results The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively. Conclusions Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system. Key messages • Notable increases are expected in health care expenditures up to 2040. • Impacts of demographic changes varies markedly between health care sectors.